Over the past decade and a half, the United States has seen a "dramatic" rise in rates of diagnosed diabetes, according to a study from the Centers for Disease Control and Prevention (CDC). The study editors suggest the rise is likely due to people with diabetes living longer as well as increases in diabetes cases.

A report on the study is published in the 16 November issue of the CDC's Morbidity and Mortality Weekly Report (MMWR).

Diabetes Rises Across the US

The report shows that between 1995 and 2000 the prevalence of diagnosed diabetes in all states of the US, plus the District of Columbia and Puerto Rico, increased by 50% or more in 42 states, and by 100% in 18 states.

Ann Albright, director of CDC's Division of Diabetes Translation, says in a press statement that in 1995, there were only three states, the District of Columbia and Puerto Rico, where 6 out of 100 people or more had been diagnosed with diabetes.

"By 2010, all 50 states had a prevalence of more than 6%", she adds.

By region, the largest increases are in the South, followed by the West, Midwest and Northeast, says report first author Linda Geiss.

The states showing the largest increases are Oklahoma (226%), Kentucky (158%), Georgia (145%), Alabama (140%), and Washington (135%).

The report shows that in 2010, six states plus Puerto Rico have a diagnosed diabetes rate of at least 10 adults in 100. The six states, all in the South and Appalachia, are Alabama, Mississippi, South Carolina, Tennessee, Texas and West Virginia.

"These data also reinforce findings from previous studies, which indicate that the prevalence of diagnosed diabetes is highest in the southern and Appalachian states," adds Geiss.

The states with the lowest diabetes rates in 2010, that is between 6.0 and 6.9%, are Alaska, Colorado, Connecticut, Iowa, Minnesota, Montana, North Dakota, Oregon, South Dakota, Wisconsin, Vermont and Wyoming.

Telephone Survey

Geiss and colleagues analyzed data from the Behavioral Risk Factor Surveillance System, an annual telephone survey that asks adults (people aged 18 and over) across the US a range of questions about their health.

The survey asks people whether a doctor has ever told them they have diabetes, and while it does not distinguish between type 1 and type 2 diabetes, it is known that 90 to 95% of diabetes patients in the US have type 2, which can be prevented through lifestyle changes.

The figures exclude women told that they had diabetes only during pregnancy, and people told they had prediabetes or borderline diabetes.

Obesity Highlighted as a Driver of Diabetes

The report editors suggest the main driver of these increases is the rise in incidence of diabetes in the US since 1990. This could be as a result of many things, including changes in how the disease is diagnosed, improved ways of detecting it, changes in the population (for instance more older people and minorities who have an increased risk for the disease), and a rise in the risk factors, such as obesity and sedentary lifestyles.

"Although the contribution of each factor to increasing diabetes incidence cannot be discerned, the increase in diabetes prevalence coincides with the increase in obesity prevalence across the United States," they note.

Albright says:

"These rates will continue to increase until effective interventions and policies are implemented to prevent both diabetes and obesity."

CDC Initiatives

The CDC says it is working with a number of partners to offer ways to prevent type 2 diabetes and reduce complications in people who have already been diagnosed with the disease.

One of these is the National Diabetes Prevention Program, that helps people change their lifestyle to reduce risk of developing type 2 diabetes. This is done through a network of classes aimed particularly at obese and overweight people.

Another initiative is the National Diabetes Education Program, which provides resources to prevent or delay the onset of type 2 diabetes, promote early diagnosis, and improve the treatment and outcomes for patients.

And the latest initiative, whose launch coincides with this report, is the Diabetes Interactive Atlases, "which provides data for diagnosed diabetes, obesity and leisure-time physical inactivity at the national, state and county levels".

The Interactive Atlases also include motion charts showing trends in the growth of diabetes and obesity across the US and within its states.

Written by Catharine Paddock PhD